Why is iStent / iStent Inject?

• Long-term outcomes (5-7 years) show sustained intraocular pressure (IOP) reduction and decreased reliance on glaucoma medications. (SpringerLink)
• Combined procedures (iStent + phaco) and standalone iStent inject have been shown effective in many studies. (BioMed Central)

Indications / Ideal Cases

• Mild to moderate primary open-angle glaucoma (or normal‐tension glaucoma in selected patients)
• Patients seeking reduction in medication burden
• Eyes with open angle anatomy and reasonable anterior chamber access 

Limitations

• Modest IOP lowering compared to filtering surgeries
• Efficacy may diminish over time

Optional / helpful adjuncts during surgery

• Anterior segment intraoperative OCT (if available) for verification
• Fluorescein or trypan blue – to test patency (if needed)
• Lighted gonioprism or modified gonio-lens with illumination
• Iris retractor or small iris hook (in cases of narrow angles)

Key “pearls” / suggestions (from experienced surgeons)

• The view is paramount — tilt and adjust until the trabecular meshwork is facing you en face. (Glaucoma Today)
• You don’t need force; a slight dimple is enough to confirm canal entry. (Glaucoma Today)
• Use dual stents to increase chance of engaging functional collector channels.
• Maintain good chamber stability, avoid collapse, trauma.
• After stent insertion, avoid vigorous irrigation until you are sure the stents are stable.
• In early cases, mark the stent location on the corneal periphery to aid postoperative localization. 

Suggested Resources & Further Learning

Video / Teaching Demonstrations                                             

• iStent inject Procedure Teaching Video (Dr. Inder Paul Singh) — Eyetube platform (Eyetube)
• iStent inject Teaching Video – Dr. Paul Singh on YouTube (YouTube)
• iStent Inject Implantation – AAO Master Class in MIGS (Dr. Ike Ahmed) (AAO)
• MIGS University: iStent Inject Video Series (YouTube)
• Ike Ahmed – iStent inject W Surgical Footage (YouTube)
• https://www.youtube.com/watch?v=CxR5cNR-HOM
• https://www.youtube.com/watch?v=DNT036wVeEU
• https://www.youtube.com/watch?v=ht5NLGou_18

Key Articles / Reviews

• “iStent inject: comprehensive review” (J Cataract & Refractive Surgery) — overview of device, outcomes, safety (Lippincott Journals)
• “Keys to Success With the iStent inject” — pearls from experienced surgeons (Glaucoma Today)
• “Five-Year Outcomes of iStent inject Implantation” — long-term real-world results (PMC)
• “Long-Term Endothelial Safety Profile With iStent inject” — endothelial implications (Ajo)
• “Prospective 12-month outcomes of combined iStent inject + phaco in Asian eyes” (BioMed Central)
• “Comparison of surgical outcomes between iStent inject W implantation and microhook trabeculotomy” (Frontiers)
• “Real-world assessment of second-generation trabecular microbypass” (ScienceDirect)